Using volume-time curves with real-time three-dimensional echocardiography to analyze right ventricular function in patients with pneumoconiosis.

We evaluated right ventricular function in patients with pneumoconiosis using real-time three-dimensional echocardiography (RT3DE). A total of 80 consecutive patients were prospectively recruited, 44 of whom were diagnosed with pneumoconiosis, and the remaining 36 age- and gender-matched healthy volunteers served as the control group. All patients underwent both 2D and 3DE. The tricuspid regurgitation pressure (TRPG), right ventricular anterior wall thickness and range of motion, right ventricular posterior wall thickness and range of motion, right ventricular end-diastolic volume, right ventricular end-systolic volume, and right ventricular ejection fraction (RVEF) were measured. The RVEF of healthy volunteers ranged from 50 to 78%, while the RVEF of pneumoconiosis patients ranged from 29 to 73%. TRPG influenced RVEF by 77.3% (P = 0.006) and showed a negative correlation (r = -0.643, P < 0.01). Volume-time curves (VTC) of patients with pneumoconiosis showed more troughs (low stroke volumes) than the VTCs of normal subjects. Evaluation of right ventricular function in patients with pneumoconiosis using RT3DE can provide additional clinical information.

Pneumoconioses: atualização / Pneumoconiosis: update

As pneumopatias ocupacionais tem se constituído num tópico importante no contexto das políticas nacionais onde se observa gradualmente uma implementação nas diretrizes da saúde pública em relação à saúde do trabalhador. O presente artigo tem como objetivo apresentar uma revisão literária sobre o assunto, destacando as formas clínicas mais prevalentes no Brasil e buscando correlacionar os aspectos preventivos e médico-legais envolvidos nas pneumoconioses.

The occupational pneumopathy has become an important topic in the contex of national politics where we can see a gradual implementation of public health guidelines in relation to the worker health. The present article has the objective to present a literary revision about the issue, highlighting the most common clinical forms in Brazil, trying to correlate the preventive and legal medicine aspects involving pneumoconiosis.

Pneumoconiosis after sericite inhalation.

BACKGROUND: Between 1997 and 1999 three sericite plant workers in Parana, Brazil, were diagnosed with pneumoconiosis. AIMS: To investigate and describe the radiological, clinical, and pathological changes in miners and millers exposed to sericite dust with mineralogical characteristics of inhaled dust. METHODS: The working premises were visited to examine the sericite processing and to classify the jobs according to make qualitative evaluation. Respirable dust was collected and the amount of crystalline silica and particle size distribution were measured. Forty four workers were examined by a standard questionnaire for respiratory symptoms, spirometry, and chest x ray. Material from an open lung biopsy was reviewed for histopathological and mineralogical analysis, together with sericite samples from the work site to compare the mineral characteristics in lung lesions and work area. RESULTS: Respirable dust contained 4.5-10.0% crystalline silica. Particle size distribution showed a heavy burden of very fine particles (23-55%) with a mean diameter of <0.5 microm. Mean age of sericite miners was 41.0 (11.9) and mean number of years of exposure was 13.5 (10.1). In 52.3% of workers (23/44), chest radiographs presented a median category of 1/0 or above, and 18.2% (8/44) had a reduced FEV1. There was a significant association between exposure indices and x ray category. Histological studies of the lung biopsy showed lesions compatible with mixed dust fibrosis with no silicotic nodules. x Ray diffraction analysis of the lung dust residue and the bulk samples collected from work area showed similar mineralogical characteristics. Muscovite and kaolinite were the major mineral particle inclusions in the lung. CONCLUSION: Exposure to fine sericite particles is associated with the development of functional and radiological changes in workers inducing mixed dust lesions, which are distinct histologically from silicosis.

[Spirometry in workers in a wheat-processing industry]. / Espirometría en trabajadores de una industria procesadora de trigo.

In order to determine both clinical and spirometric changes due to high environmental concentrations of wheat dust at a wheat processing plant mill, 48 exposed men and 48 age and antroprometrically-matched, non-exposed apparently healthy men were studied. In both groups a medical and occupational history were taken, and spirometric measurements were carried out, that included Forced Vital Capacity (FVC), Forced Expiratory Volume at the first second (FEV1), Peak Flow Rate (PFR), Forced Percentual Expiratory Volume (FEV%), Forced Percentual Vital Capacity (FVC%), Forced Expiratory Flow at 25% (FEV25%), at 50% (FEV50%) and at 75% (FEV75%) of their Forced Vital Capacity, which were analyzed through Corzo's predictive equations and the lung deterioration's criteria by USA's Thoracic Association. The environmental wheat dust was determined by gravimetry and its concentration was higher than the legally admitted (3/5, 60%). There was a decrease in the PFR, FEV%, FEV25% and FEV75%. (p < 0.05). In addition, 4 restrictive and 1 obstructive syndrome were detected in the exposed workers and none in the control group. The spirometric values diminished in a positive correlation with the time of exposure and smoking habits. There was no correlation between the clinical findings and the dust concentration but it did exist with the spirometric values. It is concluded that in this plant, the wheat dust exposed workers have a diminished spirometric values.

[Pneumoconiosis and exposure to wood]. / Pneumoconiose et exposition au bois.

The authors report a case of an employee in the wood processing industry. The clinical presentation was respiratory with dyspnoea on effort. The chest x-ray showed bilateral interstitial changes. Following bronchioalveolar lavage electron microscopic studies showed evidence of silica particles. Respiratory function tests showed pulmonary performance of 51%-64% of theoretical values depending on the test used. His working position involved the up keep of the boilers and also the drainage of the silos for wood dust. The wood used was corupixa, a brazilian wood containing crystalline silica; 0.1% in fresh wood dust. Numerous analyses have specified the percentage of silica in the ashes in magma. The diagnosis of pneumoconiosis of the silicotic type was sustained. The occupational risk linked to using this type of wood should be understood and the need to take protective measures for the employees concerned.

Diagnóstico de las enfermedades del tórax / Diagnosis of diseses of the chest

Enfermedades embólicas y trombóticas de los pulmones. Hipertensión y edema de pulmón. Enfermedades de las vías áereas. Enfermedades pleuropulmonares causadas por la inhalación de polvo inorgánico. Enfermedades pulmonares causadas por aspiración de cuerpos extraños

Diagnóstico de las enfermedades del tórax / Diagnosis of diseses of the chest

Enfermedades embólicas y trombóticas de los pulmones. Hipertensión y edema de pulmón. Enfermedades de las vías áereas. Enfermedades pleuropulmonares causadas por la inhalación de polvo inorgánico. Enfermedades pulmonares causadas por aspiración de cuerpos extraños